Development of a Successful Surveillance Model for Foot and Mouth Disease in Pakistan M. Hussain, M. Afzal, E. Khan, J. Arshad, N. Panhwer and A. Ahmad FAO, Pakistan Office, Islamabad

FMD Surveillance – Pre-project Scenario FMD is a notifiable disease in Pakistan Primarily reported through a passive surveillance system Monthly report submitted by veterinary assistant / veterinarian to district livestock officer who collects the information and passes on to the Director Animal Health in each Province. Each province sends a monthly report to the Animal Husbandry Commissioner (CVO) in the Federal Government On an average 30-50 outbreaks of FMD were reported annually No national SOP existed to handle each FMD outbreak

Veterinary Service Infrastructure in Pakistan Province / Region Hospitals Dispen-saries Centres Mobile Dispensa-ries Diagnostic Labs Punjab 523 1299 1782 98 36 Sindh 119 60 786 23 7 Khyber Pakhtunkhwa 115 511 576 8 Balochistan 116 783 - 12 15 Gilgit-Baltistan 21 167 27 Azad Jammu & Kashmir 59 66 129 5 FATA 31 246 472 4 Islamabad Capital 1 Total 988 3139 3772 141 82

Essential Elements of the FMD Surveillance Model Awareness of farmers and other stakeholders Capacity building of veterinary field staff Provision of sample collection and dispatch kit to the field staff Cover expenditure of sample collection and dispatch to the diagnostic lab Reported outbreak is responded back with outbreak control activities Report lab results to the field veterinary staff

Awareness Seminars for Farmers Province / Area Seminars # Farmers trained # Punjab 37 1070 Sindh 15 909 Khyber Pakhtunkhwa 36 2179 Balochistan 10 262 FATA 318 Gilgit – Baltistan 7 195 Azad Jammu & Kashmir 26 845 Islamabad 2 72 Total 143 5850

Capacity building of field staff Province / Region Workshops (#) Vets trained (#) Paravets trained (#) Sample collection Kits provided (#) Punjab 36 859 173 704 Sindh 17 452 133 395 Khyber Pakhtunkhwa 8 217 18 116 Balochistan 5 188 27 163 Gilgit-Baltistan 2 38 -  35 Azad Jammu & Kashmir 7 137 74 119 Federally Administered Tribal Areas 3 50 30 Islamabad 53 22 Total 80 1994 447 1615

Reported FMD Outbreaks (2012) Province Total FMD outbreaks Outbreak (#) due to serotype ELISA Negative Outbreaks O A Asia-I O+ Asia-I O+A A+ Asia-1 Punjab 164 72 19 28 14 2 1 27 Sindh 686 394 51 97 21 8 4 111 Khyber Pakhtunkhwa 120 24 6 15 5 - 55 Balochistan 7 3 Gilgit- Baltistan FATA AJK 60 22 18 Islamabad 11 Total 1088 533 103 147 50 230

Reported FMD Outbreaks (2013) Province Total FMD outbreaks Outbreaks (#) due to serotype ELISA Negative Outbreaks O A Asia-I Mixed Punjab 177 65 47 21 3 41 Sindh 2364 991 959 80 22 312 Khyber Pakhtunkhwa 171 61 44 2 17 Balochistan 42 15 - 1 23 Gilgit-Baltistan 7 5 FATA 18 11 AJK 89 31 25 28 Islamabad 6 Total 2874 1166 1091 110 48 459

Reported FMD Outbreaks (2014) Province Total FMD outbreaks Outbreaks (#) due to serotype ELISA Negative Outbreaks O A Asia-I Mixed Punjab 417 291 37 19 2 68 Sindh 1168 679 92 115 111 171 Khyber Pakhtunkhwa 407 187 24 38 158 Balochistan 193 107 15 16 55 Gilgit-Baltistan 10 7 3 FATA 29 17 12 AJK 534 310 6 5 207 Islamabad 31 11 Total 2813 1629 188 196 119 681

Reported FMD Outbreaks (2015) Province Total FMD outbreaks Outbreaks (#) due to serotype ELISA Negative Outbreaks O A Asia-I Mixed Punjab 202 74 39 33 - 56 Sindh 651 211 215 21 140 58 Khyber Pakhtunkhwa 7 16 9 Balochistan 37 11 19 1 6 Gilgit-Baltistan FATA 3 AJK 100 30 31 2 Islamabad 23 12 Total 1055 339 325 77 141 167

Reported FMD Outbreaks (Jan-Mar 2016) Province Total Outbreaks Serotype O SerotypeA SerotypeAsia-1 Mixed ELISA Negative Punjab 218 66 35 62 6 49 Sindh 241 52 50 71 10 58 Khyber Pakhtunkhwa 14 5 2 - Balochistan 1 3 Gilgit-Baltistan FATA AJK 25 11 Islamabad 28 4 19 Total 531 136 94 162 16 123

Reported FMD Outbreaks (Apr-Jun 2016) Province Total Outbreaks O A Asia-1 Mixed ELISA Negative Punjab 96 8 9 52 2 25 Sindh 184 48 39 51 44 Khyber Pakhtunkhwa 26 1 15 7 Balochistan 22  - -  11 Gilgit-Baltistan 3   FATA AJK 14 4 Islamabad Total 356 69 59 134 5 89

Conclusions Surveillance model seems to be well suited for endemic settings Application of surveillance model significantly improved FMD outbreak reporting in the country The surveillance model assisted in determining the disease pattern as well as hot spots in the country A Risk Based Control Strategy (RBCS) was developed. This strategy has been approved by the Government of Pakistan and a national program based on the strategy is under active consideration of the Government

Acknowledgements Excellent support of all livestock departments particularly field veterinarians for the implementation of project activities FMD-WRL UK for sub-typing and vaccine matching PIADRC, New York for collaboration in genotyping and vaccine matching Support of AHC Office and NVL All stakeholders particularly livestock farmers USDA for financial assistance

Thank you!